Acute Cardiac Arrhythmias Following Surgery for Congenital Heart Disease: Mechanisms, Diagnostic Tools, and Management

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Mechanisms of cardiac arrhythmias

In the immediate postoperative period, acute arrhythmia management can be challenging. To optimize patient outcomes, it is beneficial to identify the mechanism and severity of the arrhythmia with respect to overall hemodynamics and to intervene with a brisk treatment plan. The goal of these interventions is to re-establish a normal cardiac rhythm as rapidly as possible in order to avoid unwanted sequelae. Because the mechanism of the arrhythmia can be pivotal in determining the best

Arrhythmia overview

Supraventricular tachycardia (SVT) is a broad category of arrhythmias that includes atrial tachycardia, AF, and JET. Owing to the fact that these arrhythmias can originate anywhere above the bifurcation of the bundle of His, they generally exhibit the same QRS complex on the surface ECG as that of sinus rhythm. The P waves are often not visible or are hard to discern due to the rapid ventricular rate. Additional testing may be required to differentiate the type of SVT. The most common form of

Tools for diagnostic evaluation

Although it is not always possible to differentiate arrhythmias based on their mechanisms, it is helpful to distinguish arrhythmias based on common characteristics and behaviors.20 In critical situations, a clinician must be able to discern the type of arrhythmia quickly and intervene in order to prevent further deterioration of the rhythm and preserve hemodynamic stability of the patient. There are several tools available to assist in the diagnosis of early postoperative arrhythmias.

Management of postoperative arrhythmias

The urgency in the management of arrhythmias in the postoperative period is based on a patient’s hemodynamic status and, in part, by the mechanism of the arrhythmia. If the mechanism of the arrhythmia is unclear, a clinician may use the diagnostic tools (discussed previously) to identify the rhythm abnormality. Multiple modalities may be used in the treatment of these arrhythmias. The hemodynamic status of patients largely determines in what order these modalities are implemented. The treatment

Nursing considerations

Nursing care of pediatric postoperative surgical patients can be challenging. Nurses must be aware of physiologic processes, changing hemodynamic status, impact of medications and interventions on the arrhythmia, and the psychodynamics of patients and families. Nurses should recognize a postoperative rhythm and intervene swiftly if hemodynamic status is compromised. If feasible, patients and families should be informed about the rhythms, their impact on patients, and interventions required to

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